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Risk Factors for Sacral Insufficiency Fracture After Pelvic Irradiation for Cervical Cancer
Masato Saito1, Tomokazu Hasegawa2, Akemi Ohtani1
1Division of Radiation Oncology and Interventional Radiology, Department of Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan.
In Vivo (Athens, Greece)
|June 30, 2026
Summary
Sacral insufficiency fractures (SIF) after cervical cancer radiotherapy are linked to low body mass index (BMI) and higher mean sacral radiation doses. Identifying these risk factors can help prevent SIF and improve patient quality of life.
Area of Science:
- Oncology
- Radiation Oncology
- Radiotherapy
Background:
- Sacral insufficiency fracture (SIF) is a significant complication following pelvic irradiation for cervical cancer.
- SIF can negatively impact patients' long-term quality of life.
Purpose of the Study:
- To identify clinical and dosimetric factors associated with SIF after pelvic radiotherapy for cervical cancer.
Main Methods:
- Retrospective analysis of 121 cervical cancer patients treated with pelvic radiotherapy.
- Evaluation of sacral dose-volume histogram parameters and CT attenuation.
- Correlation of clinical factors (age, BMI) with SIF development.
Main Results:
- SIF occurred in 25.6% of patients.
- Univariate analysis showed age ≥55, BMI ≤20.5, mean sacral dose ≥38 Gy, and low sacral HU were associated with SIF.
- Multivariate analysis identified low BMI and higher mean sacral dose as independent predictors of SIF.
Conclusions:
- Low BMI and elevated mean sacral dose are independently associated with SIF post-radiotherapy for cervical cancer.
- A mean sacral dose threshold of 38 Gy may be relevant, requiring further validation.
- Fractures tend to occur in high-dose regions within the sacrum.
